Rights
Medical
Wider Range of Viewpoints
In 2023, The American Medical Association (AMA) created a draft version of Amendment 706 that included withdrawing support for ABA. It was introduced by the Medical Student Section. The full resolution proposal is outlined in the AMA House of Delegates Handbook (pp 1179–1182).
The outcome was that the resolution modified the wording to express support for all evidence-based care and no longer specifically called out support for ABA (but did not withdraw support for it specifically either). Although amendment 706 did not go into effect, its introduction does indicate a wider range of viewpoints at the AMA.
Another shift in viewpoints is by ABA providers. More ABA providers are leaving the field and writing about their concerns around ABA (stopabasupportautistics, 2023; ANXIOUSADVOCATE, 2015).
Medical Neglect
A doctor who recommended ABA for a child, may think they are in their rights to report a caregiver for medical neglect, if they refused ABA. This is because the American Academy of Pediatrics definition of medical neglect includes this language:
“. . . either failure to heed obvious signs of serious illness or failure to follow a physician’s instructions once medical advice has been sought.”
However, most providers agree that medical neglect requires that 3 essential criteria are met:
The child is harmed or is at risk for harm because of lack of health care,
The recommended health care offers a significant net benefit to the child,
The anticipated benefit of the treatment is significantly greater than its morbidity.
When these criteria are included, refusing ABA for a child does not meet the definition of medical neglect.
One could argue that a physician who does not share the risks of ABA is not providing adequate medical care and are meeting the criteria for medical neglect themselves.
This is because physicians should ethically keep in mind “Of the Epidemics” by Hippocrates when performing their duties. This text includes:
“The physician must be able to tell the antecedents, know the present, and foretell the future — must mediate these things, and have two special objects in view with regard to disease, namely, to do good or to do no harm.”
Since there are risks to ABA it is ethically reasonable for physicians to share the risks of ABA with caregivers, as one would with any other medical recommendation.
Resource: Medical Neglect – Physician and Court Ordered ABA for Autistic Children (Therapist Neurodiversity Collective, 2024)
Filing a Medical Complaint
One option is that a caregiver can file a complaint against a physician for either:
Reporting a caregiver to a state’s Department of Children & Families Department for “medical neglect” or threatening to, for the reason of refusing ABA.
Withholding information about the medical risks of ABA.
A complaint can be filed against a physician by contacting the appropriate state’s medical board. The Directory of State Medical and Osteopathic Boards can be accessed from the Federation of State Medical Boards (FSMB) website.
For MA residents complaints can be made through the Board of Registration in Medicine.
Resource: 243 CMR 1.03(4)(a) for the specific grounds for complaints against physicians (PDF pages 5-6). A caregiver may file a complaint against a physician if they allege that a physician is practicing medicine in violation of the law, regulations, or good accepted medical practice.
Medical Support
Healthcare settings are moving towards being more inclusive to neurodivergent patients. Some of these approaches could be incorporated into educational spaces as well.
Resources:
“Autistic SPACE: a novel framework for meeting the needs of autistic people in healthcare settings” (Doherty et al, 2023).
An Experience Sensitive Approach to Care With and for Autistic Children and Young People in Clinical Services (McGreevy et al, 2024)
Childcare
Some caregivers welcome ABA because it can appear to offer childcare (20-40 hours a week) that financially is free or at a low cost. If a child has a diagnosis of autism, or has documentation of a disability caregivers may have other options as well. Autistic children and students with other disabilities may be eligible for subsidized early intervention (birth to age three).
Information about early intervention:
Throughout the United States.
Within MA.
Also in MA, free K1 schooling (the year before traditional kindergarten) may be available in local school districts, as well as free family respite through the Department of a Developmental Services (DSS). Family respite is also possible with MA based Caregiver to Caregiver Respite Network.
Image Credit: Modified from from Freepik.com